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AAAOM Medicare Town Hall

Sorry to say I missed the beginning of the call — the instructions to join were not easily available or straightforward. At the peak, there were about 70 participants.

Bottom line, the AAAOM lacks the level of expertise they need before moving this legislation forward. The AAAOM does not have an idea of how many LAcs are likely to opt in, didn’t have the correct history of why the Chiropractors do not have the opt-out clause (and seemed to believe they currently can opt-out), didn’t realize that becoming part of the system would limit the amount non-participating providers could bill Medicare clients (a participant provided correct information), wasn’t clear that other providers would be able to bill for acupuncture if it becomes a covered service, hadn’t considered the impact on the practices of practitioners opting out, etc. The information about enrolling, opting in or out, participating or non-participating was still unclear.

A caller suggested it is premature to ask practitioners whether they’ll be likely to opt in — there are too many unknowns. I understand, but don’t we need some idea before we spend millions moving forward with the legislation? A few callers seemed confused about the difference between acupuncture as an EHB and the proposed legislation. Others seemed to think the legislation had already been introduced.

The bill writer/lobbyist wasn’t willing to make predictions, but I’ll go out on a limb. The AAAOM says they need about $1,000,000/year to move this legislation forward and the fundraising remains at around $25,000. According to the lobbyist she’s only been contracted for a month. The current Congress (113th) ends January 3rd, 2015. I say there is a 0% chance any of these bills will pass in the next year.

Would the AAAOM please focus their efforts on things that could help all practitioners now? In an ideal world they could work on both long term and short term projects, but this isn’t an ideal world. Without evidence that a significant majority of the profession intends to participate, why oh why is this legislative effort their only focus?

You didn’t mean to insult when you mentioned everyone else managed to execute the instructions to join the call? (And, how do we even know?) Anyway, I’m waiting for some critical thinking — and for you to tell us who you are. Good luck with the change.

Just wanted to tell you how much I adore you today for your tenacity and ability to look beyond so much double-speak, keep a clear eye on the proceedings, inform so many of your colleagues with transparency and integrity, and press these important, reality based points about process, cost, best use of resources and representing the real consequences to practitioners of these campaigns. Especially in the face of comments clearly meant to insult and incite. Bravo!

Disagree. No intent to incite or insult. Insults are easy and if that was the intent you would have seen them. If this is a forum for critical thinking then let us do that rather than just “take sides” as you seem to imply. If someone is going to create a soapbox for themselves but not use any soap to clean up the mess I felt like that was worth a mention too. Good luck here. Off to be the change – not just talk about it. H.D.

Elaine – you hit the nail on the head, especially when you say that the information is only useful if you already knew the answers. I was traveling for the holidays last night so only logged in for the last 60 minutes. However, I was disappointed that 1) the questions seemed by and large focused solely on Medicare … this is supposed to be a package of five pieces of legislation, all of which are stand-alone, would require their own funding, would likely have to pass through different sub-committees. I could support some of the other legislation if the Medicare piece was put on the shelf until and if ever much more of the profession is interested.; 2) a lot of the questions were focused on how this *might* benefit certain providers – and the answers were opinions presented as fact. Here in Maryland, we are quite successfully included in institutions such as major medical hospitals, large private insurers, and now the state’s benchmark plan. We did all this through decades of proving ourselves as legitimate health providers without needing “Medicare” to be included. It is possible for other states, and it is simply an opinion that inclusion in Medicare will make it happen quicker and easier – and opinion that many disagree with; 3) questions should have been focused on what it takes to pass such legislation – not what the end result will be. More financial questions should have been asked so that the community fully understands what it takes to be successful (getting a bill heard in committee is not considered success) and where we stand in relationship to that financial need. Questions should have been asked regarding how many sponsors and co-sponsors we have, what relationships do we have with potential supporters and potential opposition (do we have a relationship with the AMA? They would crush us in a heartbeat if they decided to oppose), what relationships do we have with the committee chairs where these bills will be heard? What about support from the profession – at the Dallas AAAOM Membership meeting, the number of members reported represented less than 2% of the profession. If I walked into our state legislature with such a low membership number, I’d be laughed out of the room. What efforts are being made to increase membership so that we as a community have a presence on the Hill? So many things that are more important for us to understand and know than just “how will this benefit me when it’s passed”.

H.D. – I thank Will M. for stepping up to facilitate this Town Hall. It’s a first step in the right direction. The scheduling of this Town Hall was very unfortunate. I sit on the Board of one of the state acupuncture associations and I can assure you that the states have been asking the questions I referenced above for over a year now since the first email was sent out to us requesting we support these bills. We have yet to receive these answers. Many of us whom would have been on the call asking these questions, again, were traveling. I was told that the need for advance notice superceeded the inconvenience of the weekend. I make my holiday travel plans 6 months in advance. Why couldn’t the Town Hall have been scheduled for this upcoming weekend instead of the Sunday after Thanksgiving? I ran into my house after driving for 4 hours and immediately logged on to the end of the call – I decided not to ask any questions because I did not know what had already transpired. I will be emailing in my questions, again. Choosing the busiest travel weekend of the entire year to have a Town Hall, in my opinion, is a symptom of the problem – there has been very little true communication and involvement with the profession as a whole, and what involvement has occurred has been poorly designed and communicated in order to achieve true input. The previous comment periods were not only extremely short – so as to make it difficult to review the bills and give substantive comments, they also were not well advertised (I am both an individual member of AAAOM and my state association is an organizational member, and I did not receive notification of the two prior comment periods until after they closed).

I completely disagree with your take on the call though I’m glad you were able to attend a portion of it.

To my knowledge and according to the explanation you missed when you were not on the call (apparently due to the instructions the rest of us were able to execute) the 70+ participants shown on the computer were only those using a computer. 200+ people had called in via the telephone. The AAAOM could probably verify this.

Almost everyone – except you – seems to be supportive of the community and the work done by a completely volunteer board. I find it amusing that you flash “your time on the board” as a badge of honor. Since you quote “what I heard” I’ll do the same and say that based on your reputation in the community you caused more sleepless nights than you experienced during your notably short tenure.

It would be excellent for acupuncturists in the profession to start attending calls like this and making their own decisions rather than listening to others – especially those known to have very little positive to say or to contribute.

How are you going to be a part of the solution? Can you provide an answer to that? How do you seek to unify the profession and bring this medicine to those in need? Doing some-thing is better than no-thing.

I’m glad I was able to join it too, and sorry that I missed the beginning. I’m glad to hear there were more attendees on the phone, I was indeed going by the number I could see on my screen.

Truth, it would be great to know who you are — are you willing to share your name? What I can say about my time on the board is that I am far from the only board member who reports problems with the function of the organization. I am sure I did cause some sleepless nights — folks who had expected to have the board rubber stamp spending without a budget, for example, were now asked to present one. I raised concerns about meetings with no agendas, no supporting documents, no minutes from the last meeting, actions taken based on what the lawyer said when only one board member had any access to the lawyer, etc. The proof is in the pudding — how successful has AAAOM been, what is their track record with staff, how has membership grown in the past few years, how does the information and services they provide compare with other professional organizations? I’m not flashing my board service as a badge of honor by any means. Folks have not exactly been falling over themselves to serve. There was a need, I thought my experience would be appreciated and useful, it wasn’t, so be it. I stepped down from the board when it was clear I would be unable to fulfill my responsibilities to the membership. The board was not provided the necessary information to make good decisions. Two other board members stepped down at the same time, and I don’t think we’ll be the last to make that decision.

I’m not sure who “almost everyone” is. The organization’s membership and lack of fundraising success don’t seem to support your claim that the AAAOM has wide support. I am grateful for the service of those who do step up.

I completely agree that more people should get involved and participate and have done my best to encourage people to do so. I’m doing my best to share resources with people so that they can make informed decisions. That is one of the things I am doing. I am encouraging honest conversation, I am presenting people with ideas about how to make this medicine available to those in need. To me, it is not positive to become part of an echo chamber. It is not good for the profession to make decisions based on a misunderstanding of the implications of their choices.

You tell me, how can one discuss the faulty reasoning in a proposed solution without being seen as someone with nothing positive to contribute. Is the only action acceptable to say, gee whiz, I think that’s great, let’s go for it?

In fact, today’s AAAOM website shows three fewer board members than yesterday’s. Long term VP Kim Benjamin doesn’t appear on the list, and Daerr Reid and Jennifer Minor seem to be missing too. It isn’t election season. Perhaps we’ll find out more soon about how things are going over at the AAAOM.

The difference is that anyone can point out the problems. I’m sure the AAAOM knows they aren’t perfect. They are in fact flawed in many areas and would probably not argue with such criticism. That is not the issue at hand. The issue is “How do we as practitioners support moving our profession forward in a tangible way?” Critique and criticism from the sideline hasn’t been constructive and never is. At the least, the very least, these bills appear to have been created by experts within and outside the community, have received feedback 3 times from the community and are now ready to move forward. Perhaps they don’t have a high chance of success. Perhaps they do. But with the kind of support like they get in this “echo chamber” what do you expect? How about we get behind just 1 thing as a community and make that a success – just one! Show us – don’t just tell us – show us how to create real change on a national level. I for one, would treat Medicare patients. My grandmother deserves acupuncture care and so do others. How will YOU make this happen? Is it truly better to not get involved with something even if you think it will fail rather than TRY and see what happens? H.D.

I’m unsure how to proceed — if there are critiques you say it is easy to complain, if there aren’t critiques you say everyone supports it. I have tried to be involved and have not been sitting on the sidelines. Please, read my bio if you are unaware of my efforts to make a difference. It doesn’t seem to be that easy to point out the problems, since many in the profession are still ill-informed about what they are, and you seem to feel I am wrong to point them out.
I agree, your grandmother, and everyone else, should have access to acupuncture. Pouring money and effort into a bill that won’t succeed will be no help at all. We’d be better off to do pro bono work now, or support more CA clinics, or agree to do some percentage of free or seriously discounted treatments every week. That would begin making a difference now.
By echo chamber, I meant they only listen to themselves. Is that what you meant?
I am glad they got a bill writer involved. She may be an expert, but she was wrong about at least two things yesterday, maybe more.
Is the only acceptable response in your book to shut up and get on board, even if I have reason to believe it will be bad for the profession.

H.D
My father passed at 89. I treated him and other elderly people. Not all elderly people are financial challenged. In fact I have treated very wealthy elderly clients who can easily access anything they want. Hey, I have treated young people with barely two pennies to rub together. Being a Medicare provider does not cover the issue. Elaine has mentioned some interesting topics in other postings – such as sliding scale and CA. What’s the hard reality here? Not everyone will be able to afford to get acupuncture. I would love to drive a Audi, but it’s not going to happen anytime soon. The Audi dealership doesn’t feel bad for me. The sales guy deserves to make a living, he’s not going to give away his cut of a sale. This is the hard part of our business (yes, my clients are my customers). Many acupuncturists don’t understand how to run a business and make a living from it. That topic would be a better start than jumping into Medicare. How about educating people about the benefit of investing into their health with TCM (please notice not acupuncture) and then the practitioner can set the price. You could then charge whatever you think would be reasonable for the client if you desire.

Personally I’ve given up on treating everyone and feeling bad for people who can’t afford the price. Why? Because I could barely pay my own bills…never mind paying myself a salary. The people getting the deep discounts don’t care you’re poor too. The stress of worrying about how I was going to pay my bills reflected into my practice.

So does Medicare payment make it better financial for us? You don’t answer that. You only talk about making easier for clients. But what about the practitioner? Practices fail because they can’t make money. Will this bill solve that problem? I highly doubt it.

H.D.
I don’t support this board. I have no interest in taking Medicare and of the 10 acupuncturist I know, none of us want to accept Medicare. How can TCM practioners properly diagnose, build a treatment plan and treat the client with such poor paying Medicare? I spend easily 2/3 hours after meeting with the client to build a treatment protocol. I don’t believe in just sticking needles because the client looks like they have sp qi def. I find quick intakes and bypassing the reviewing of the patterns lead to mediocre treatment results. I’ve spent thousand of dollars to take an advanced TCM class, which has greatly improved my treatment results. When clients pay me – they are going to get the best of my ability. I will gladly take on the pressure of giving results for out of pocket payment. Medicare payout will never cover the time and money I invest in the client. Billing for a heat lamp or estim – is a sad way to recoup my worth.

H.D – why can’t the board focus on education about our medicine? People think we just stick needles – like dr’s and pt. But we don’t – we offer a medicine. And what do we get paid? $20 from the insurance, $20 co pay? $40?? That’s just the pits. So we become the next victims of having to see clients every 15 minutes? Pump them in pump them out. I personally find that unnourishing and an easy way to burn out. Never mind all the paper work that needs to be filled out. All the claims that need to be tracked. No thanks.

I don’t think Medicare or insurance will help acupuncturist stay in business. I see chiro’s suffering and struggling with insurance.

In the end, Elaine has give me more information and insight into the politics of this topic. Far more than any acupuncture group. I may not agree with her on everything….but she’s the only person putting it out there. Do you have a website for your thoughts? Maybe if you feel so disturbed, it’s time to get your message out there?

The problem is that unless you already knew the answers to the questions you would not know the AAAOM was giving out information that was incorrect. People listening in might have left with the impression that this legislation would have no impact on those who choose not to participate, that beneficiaries could get reimbursement for services from non-participating/opting out providers, that we are well situated to move forward with the legislation, that non LAcs would not be able to bill for acupuncture services, etc. The responses tell you something if you know they are wrong, but something else entirely if you believe you are getting correct information.

I would love to see the facts and data supporting the idea that your information was correct and theirs was incorrect. It’s they said – she said. Post it up! Did they not say that they would verify all questions and provide updated information?
H.D.

It’s not he said/she said. If you’ve read through my other posts, you’ll see many links leading to authoritative sources. Here is a link to the current information re. the Chiropractor opt out, billing for non-participating providers, etc.

By all means, share a place where you think the AAAOM was correct and I am incorrect and I will provide you with supporting documents.

They need to raise a ton of money to move forward. There was a question about how the money they have already raised has been spent and they said they’d be more transparent about it. So far, it hasn’t been a very successful fundraising effort and I’ve heard rumors that they’re being a bit loose about how the money is spent. Given the way money was spent in my time on the board I’d say it is easy to believe that is the case.

I don’t think they created the project for the purpose of fundraising….